Chronic kidney disease: a European perspective

There is an exponential growth worldwide of patients with end-stage renal disease (ESRD). Prevalences, outcomes, and underlying causes of ESRD are relatively well documented through different organizations. It is, however, clear that a large part of the bad outcome of ESRD patients is due to deficient follow-up during the earlier chronic kidney disease (CKD) stages. Data on CKD, prevalence of the different stages, and the evolution to ESRD are rather scant, and available data are conflictive. This is at least partly due to the lack of an international standard for measurement of renal function. In addition, there is compiling evidence that presence of proteinuria, even with a normal renal function, predisposes to ESRD. Most authors now prefer the term "kidney injury" rather than "kidney failure" to indicate people at risk for evolution to ESRD or for complications of CKD. Detection of these patients at risk is important to implement measures to slow down progression of CKD and avoid secondary complications. As it is clear that most of these CKD patients die before they reach ESRD, it might be that by taking the necessary preventive measures, the number of ESRD patients might still further increase exponentially